Sequential indium-labeled leukocyte and bone scans to diagnose prosthetic joint infection.

Teller RE, Christie MJ, Martin W, Nance EP, Haas DW
Clin Orthop Relat Res. 2000 (373): 241-7

PMID: 10810483 · DOI:10.1097/00003086-200004000-00029

Previous studies suggest that sequential technetium-99-hydroxymethyl diphosphonate bone scanning and indium-111 leukocyte scintigraphy may play a role during revision arthroplasty. Preoperative sequential imaging was compared with joint aspiration and clinical assessment during revision knee or hip arthroplasty. Scans were considered positive if indium-111 leukocyte uptake was incongruent or focally more intense than that of technetium-99-hydroxymethyl diphosphonate uptake. Of 166 cases, 22 were infected. Sequential technetium-99-hydroxymethyl diphosphonate and indium-111 leukocyte imaging was 64% sensitive and 78% specific. Fever, physical findings, or sedimentation rate did not identify infection reliably, and preoperative aspirate culture was only 28% sensitive. Positive scintigraphy increased the likelihood of finding infection intraoperatively from 14% to 30%, although negative scintigraphy decreased this likelihood to 7%. Based on the current study, the routine use of sequential technetium-99-hydroxymethyl diphosphonate and indium-111 leukocyte imaging cannot be advocated for differentiating occult infection from mechanical failure in painful, loose total joint arthroplasties.

MeSH Terms (15)

Bacteriological Techniques Female Hip Prosthesis Humans Knee Prosthesis Leukocytes Male Middle Aged Organometallic Compounds Oxyquinoline Predictive Value of Tests Prosthesis-Related Infections Radionuclide Imaging Reoperation Technetium Tc 99m Medronate

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